A mother brought in her 2-year-old daughter, noting a “lump” in her left nipple. She said the child was healthy, current on vaccinations, and appeared in no distress. On examination, the left nipple itself appeared normal. There was no discharge or discoloration. However, palpation revealed a 2- to 3-cm mass in the retro-areolar area. It was mildly tender, smooth, and slightly mobile. The axillary nodes were not enlarged, and the opposite nipple and areola were normal. She was referred to the local children’s hospital for further evaluation. Ultrasound confirmed a diagnosis of premature thelarche. This condition is often confused with precocious puberty. However, in cases of children this young, it typically resolves over time without intervention. 

Further interventions such as biopsy are discouraged, as this can cause damage to the breast bud structure and lead to irregularities when the child begins normal breast development. The child’s breast enlargement was monitored by her pediatric specialist, and it slowly resolved within the next 4 to 6 months. (218-4)

Sherril Sego, FNP-C, DNP, is an independent consultant in Kansas City, Mo.

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